Sciatica :: Slipped disc – back surgery or physical therapy

People who opt for surgery to treat chronic back and leg pain from a slipped disc / herniated disc may do slightly better when compared with non-surgical treatments, but the difference is not significant, U.S. researchers say.

Herniated discs can improve with time and with exercise, and differences in surgery rates across the U.S., and internationally, led researchers to question if the operation is appropriate and useful.

James Weinstein of Dartmouth Medical School, Hanover, N.H., and his colleagues compared surgical and non-operative treatment for herniated discs in 1,200 people over four years. Some participants were randomly assigned to a treatment while others chose for themselves.

Sciatica is a pain in the leg caused by the irritation of the sciatic nerve. Generally, the pain travels from the back of the thigh to the back of the calf, and also may extend upwards, to the hip, and downwards to the foot. In addition to pain, there may be numbness and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term often is misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important, because treatment for sciatica or sciatic symptoms often will be different, depending upon the underlying cause of the symptoms.

The first cited use of the word “sciatica” was registered in 1450.

Most common cause is slipped disc.

Slipped disc or spinal disc herniation is a pathological condition in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to be extruded (herniated) to the outside of the disc.

It is normally a further development of a previously existing disc protrusion, a condition in which the outermost layers of the annulus fibrosus are still intact, but can bulge when the disc is under pressure.

There are a variety of non-surgical care alternatives to treat the pain, including:

Physical therapy
Osteopathic/chiropractic manipulations
Massage therapy
Non-steroidal anti-inflammatory drugs (NSAIDs)
Oral steroids (e.g. prednisone or methyprednisolone)
Epidural (cortisone) injection
Intravenous sedation, analgesia-assisted traction therapy (IVSAAT)

If pain is severe and continuous, or if there are neurological deficits, surgery may be recommended. Surgical options include:

Lumbar fusion
Disc arthroplasty
Dynamic stabilization

A study involving more than 1,200 patients at 13 U.S. hospitals found either surgery to remove a bulging back disc or a course of physical therapy both helped ease the pain and discomfort two years after treatment.